1497023709 NPI number — NORTHEAST MEDICAL RESEARCH ASSOCIATES, INC.

Table of content: (NPI 1497023709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497023709 NPI number — NORTHEAST MEDICAL RESEARCH ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST MEDICAL RESEARCH ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1497023709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 STATE RD
Provider Second Line Business Mailing Address:
WATUPPA BLDG., SUITE 202
Provider Business Mailing Address City Name:
NORTH DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-992-7595
Provider Business Mailing Address Fax Number:
508-984-5574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 STATE RD
Provider Second Line Business Practice Location Address:
WATUPPA BLDG., SUITE 202
Provider Business Practice Location Address City Name:
NORTH DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-992-7595
Provider Business Practice Location Address Fax Number:
508-984-5574
Provider Enumeration Date:
12/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
S DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-992-7595

Provider Taxonomy Codes

  • Taxonomy code: 1744R1102X , with the licence number:  74380 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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